Tip: You’ll need to specify the joint and the side.
When a patient presents with a sprain of the wrist, this means the patient presents with an injury to the ligaments of the wrist.
Currently, you have these ICD-9 options:
- 842.00, Sprain of unspecified site of wrist
- 842.01, Sprain of carpal (joint) of wrist
- 842.02, Sprain of radiocarpal (joint)(ligament) of wrist
- 842.09, Other wrist sprain
ICD-10-CM: When ICD-10 hits, you’ll have numerous more options:
Question: Our physician did an SI injection in the office without any image guidance as the C-arm was not functioning. Should I bill 20552 or 20610?
Look out: Private lawsuits can be just as costly as federal HIPAA fines.
You might think you’re in the clear as long as you have a good grip on HIPAA requirements in your organization, but that may not always be the reality. A recent court case shows you could be held responsible for a business associate’s HIPAA violation.
Background: Led by former patient Shana Springer, Stanford Hospital & Clinics and two of its vendors faced a class action lawsuit for alleged privacy breaches of patients’ protected health information (PHI), violating California’s state privacy laws. The plaintiffs sought $20 million in damages, but the defendants recently settled the case for $4.1 million.
Multi-Specialty Collection Services (MSCS) was Stanford’s business associate (BA) and was named in the lawsuit, and then another BA contracting with MSCS, Corcino & Associates, was added to the complaint. The lawsuit alleged that Stanford and its BAs were responsible for disclosing the PHI of 20,000 emergency room patients. The BA had posted an Excel file online containing the PHI.
Because the BAs were at fault for the unpermitted disclosure, they will pay the majority of the settlement — about $3.3 million, reported attorney Elana Zana in a blog post for the Seattle-based law firm Ogden Murphy Wallace. But Stanford is still stuck paying out a whopping $500,000 toward a “vendor education fund” under the settlement agreement, as well as $250,000 in settlement administrative costs.
Why ‘No Fault’ Doesn’t Protect You
Find out whether you can report 99000 for handling of the specimen.
If your patient’s Pap smear results return as abnormal or display insufficient cells, the ob-gyn will probably perform a repeat smear. Use proper E/M coding to get the payment you deserve.
Zoom In on Your Visit Code
When the patient comes in for a second Pap smear, submit the appropriate E/M service. CPT® does not include a code for taking the Pap, so you should use the office visit code (99211-99215).
You will probably report 99212 for the Pap retest visit because the patient is here only for the Pap smear.
That translates to almost $45 per visit, using the Medicare Physician Fee Schedule national rate. Code 99212 (Office or other outpatient visit for the evaluation and management of an established patient …) carries 1.22 relative value units (1.22 RVUs x 2008 conversion factor 35.8228 = $43.70).
Bill Collection Under These Criteria
The May 2014 CPT® Assistant starts off with a bang, featuring a 2014 code update article for four surgical areas: integumentary, respiratory, digestive, and urinary. Need to know what to do when the physician gets a specimen mammogram to verify calcification before the specimen heads to pathology? Want to be sure you’re reporting same-side pleural drainage and pleural catheter insertion correctly? See what the latest CPT® Assistant has to say.
You’ll find other 2014 updates in the May CPT® Assistant, too. You’ll also be able to prepare for coding beyond 2014 with helpful hints for ICD-10. Finding these articles is as simple as searching SuperCoder.com’s Code Connect by code and keyword:
- Abscess drainage, perirenal or renal: 10030, 49405-49407, 50020, 50021, 75989
- General surgery 2014 update: 10030, 13150-13153, 19081-19086, 19100, 19101, 19281-19288, 32550, 32554-32557, 32674, 38746, 50630, 51702, 52000, 52320, 52325, 52327, 52330, 52332, 52334, 52335, 52341-52346, 52351-52356
- ICD-10-CM code format
- Ophthalmology 2014 update: 12011, 12013-12018, 12051-12057, 13150-13153, 64612, 64613, 64616, 65778-65780, 66183, 67345, 67938, 68040, 92100, 92132, 92136, 92285, 0192T, 0207T, 0329T, 0330T
- Pediatric and neonatal care 2014 update: 36000, 36400, 36405, 36406, 36415, 36591, 36600, 43752, 43753, 71010, 71015, 71020, 92953, 93562, 94002, 94003, 94660, 94662, 94760-94762, 99090, 99221-99223, 99231-99233, 99291, 99292, 99466-99469, 99471, 99472, 99475-99482, 99485, 99486, 0260T, 0261T.
Question: Our patient was referred to home care following a cholecystectomy due to acute cholecystitis. She also has a history of breast cancer and is taking Tamoxifen prophylactically. She’s had some problems with urinary retention after surgery and one of her surgical wounds is dehisced. We will be discontinuing the indwelling catheter and instructing her on how to use an intermittent catheter. How should we code for this patient in ICD-9 and how will our coding change for ICD-10?
Answer: Code for this patient as follows,
Question: I billed G0268 with 92511 and had the appropriate documentation for support. One of our private payers denied the G0268 because the “related qualifying service” (Audiologic Function Testing) wasn’t billed for the same date of service. I didn’t realize you needed an audio evaluation to bill G0268. Has something changed with the codes?
West Virginia Subscriber
The answer to this commonly-held belief may surprise you.
Your physician performs CPR for a non-responsive patient in the observation care unit of the hospital, where he attends to the patient for 30 minutes, and the patient is later moved to the ICU, where your physician sees her for another 75 minutes evaluating her need for a mechanical ventilator, feeding tube and accompanying sedation while she stabilizes. Your physician bills for 70 minutes of critical care services, right? Wrong.
Myth: Although many physicians believe they can only report critical care services for patients who are in the hospital’s intensive care or critical care unit, that longstanding belief is a myth.
Include add-on codes for each additional level.
Reporting the radiofrequency (RF) ablation procedures in the spinal areas can be challenging if you do not pay attention to details. Remember, the RF ablation differs from spinal injections. Marvel Hammer, RN, CPC, CCS-P, ACS-PM, CPCO, owner of MJH Consulting in Denver, Co. shares useful tips for spinal RF ablation procedures that can help you to always submit compliant codes.
Change Your Focus from Nerves to Joints
In the past, you coded for destructive procedures based on each individual nerve, as opposed to diagnostic/therapeutic injections that are based on the facet joint level. But that changed when new codes for paravertebral facet joint destruction became effective in 2012.
“At that point the ‘counting’ methodology changed to be similar to the injection codes,” Hammer says.
Explanation: CPT® Changes 2012 explained the reason for the change.
A quick look may show you how ICD-10 divvies up sinoatrial node dysfunction code 427.81 into two distinct codes. But you’ll need to dig a little deeper to see how 427.81’s “includes” list gets assigned under the new code set.
- 427.81, Sinoatrial node dysfunction